Medical relicensure is intended to protect the public by assuring ethical behavior and a basic level of competence. But a new cottage industry would like to make it a cash cow, writes Dr. Paul Kempen, an anesthesiologist, in the winter issue of the Journal of American Physicians and Surgeons. The effort has been thwarted, at least for now, in his state, Ohio.
Board certification has until recently been a voluntary process of acquiring a lifelong certification in a specialty, after a rigorous course of training and an examination. Like passing the bar or the CPA examination, it did not have an expiration date.
From his perspective gained in two decades of teaching residents, Kempen finds that board certification serves a useful purpose to promote learning and measure individual and residency program success. There is, however, no evidence that continued Maintenance of Certification (MOC) is either necessary or helpful in improving patient care, he states.
Documents purporting to show the efficacy and importance of MOC are “grossly tainted by corporate authorship,” he writes. “They are little more than opinion papers with suspicious research designs and corporate agendas, written by individuals with pre-conceived conclusions.”
Many physicians participate in costly MOC programs only because of pressure from hospitals and insurance plans. The Federation of State Medical Boards has a long-term corporate strategy to force all physicians into these lucrative proprietary programs by getting states to mandate MOC as a condition of basic licensure, the “Maintenance of Licensure” (MOL) program, according to Kempen. Ohio was to be a pilot state.
Kempen views MOL to be akin to racketeering, or to put the best construction on it, a religion.
He outlines a successful strategy for opposition, beginning with exposure of conflicts of interest. The State Medical Board of Ohio executive director and one prior president/longstanding member of 13 years were also board members of FSMB during the FSMB MOL pilot initiative. “They both were clearly the principal zealots pressing for the introduction of this initiative,” Kempen writes. The executive director has since stepped down.
A key element, Kempen states, is “exposing the lies on which the certification industry bases its case, and the perils in allowing private corporations to use governmental power to achieve private ends without the checks and balances that could restrain public agencies.”
The Journal is an official publication of the Association of American Physicians and Surgeons (AAPS), a national organization representing physicians in all specialties, which was founded in 1943.